Brown tumor as a result of secondary hyperparathyroidism in chronic renal disease

Abstract

Introduction: Brown tumor is a focal lesion of giant cells that develops in association with hyperparathyroidism. Objective: To report a case of brown tumor that occurred in the mandibular symphysis region, associated with secondary hyperparathyroidism. Case report: A 45-year-old male patient with chronic renal failure exhibited increased volume with comorbid local paresthesia in the mandibular symphysis region. Radiographs showed a unilocular radiolucent area with partially defined edges in the anterior mandible region. The histopathological findings revealed connective tissue, rich in oval, notched cells and giant cells with hemosiderin pigments. Laboratory tests showed increased serum levels of parathyroid hormone. An attempt to control the hormone levels with medication while the patient awaited a kidney transplant was unsuccessful. Therefore, as a transplant was not imminent and injury continued to develop, the lesion was surgically excised. Three years later, the lesions recurred in the paranasal region. Following partial removal of the lesions, the patient is now under follow-up care. Conclusion: Correct diagnosis and effective treatment of brown tumor requires correlation of biochemical data with the patient's clinical, imaging, and histological profile.

Brown Tumor: A Late Complication of Secondary Hyperparathyroidism

“…Brown tumor is about three times more common in women than in men, and it is more prevalent between over 50-year-old people [5,6,10], as stated in the literature. This tumor can occur in any bone [8], but it is rare in cranial and facial bones, being more frequent in large bones [1,9,10].…”

“…Brown tumor is about three times more common in women than in men, and it is more prevalent between over 50-year-old people [5,6,10], as stated in the literature. This tumor can occur in any bone [8], but it is rare in cranial and facial bones, being more frequent in large bones [1,9,10]. However, compared to its incidence in maxillary bones, mandible is more commonly affected than the maxilla [5,6].Brown tumor is associated with either primary or secondary hyperparathyroidism, being considered the final stage of the bone remodeling process [10].…”

“…This tumor can occur in any bone [8], but it is rare in cranial and facial bones, being more frequent in large bones [1,9,10]. However, compared to its incidence in maxillary bones, mandible is more commonly affected than the maxilla [5,6].Brown tumor is associated with either primary or secondary hyperparathyroidism, being considered the final stage of the bone remodeling process [10]. In chronic renal patients, its incidence is due to hypocalcemia, hyperphosphatemia and calcitriol deficiency, all characteristic of the disease and which are responsible for the increase in PTH secretion [1], causing morphological alterations in parathyroid glands [6].Calcium and phosphorus concentrations were within or near the normal limits and were explained by hemodialysis.…”

Brown Tumor of Lower Right Limb in Patients With Primary Hyperparathyroidism: A Case Report

“…Skeletal demineralization, resulting from elevated plasma calcium, leads to multinucleated giant cells or osteoclasts replacing bone. [6] Diagnosis is best established by evaluation of serum levels of calcium and phosphorous, alkaline phosphatase and parathyroid hormone, or by finding an increased amount of urinary calcium . There is no pathognomonic histopathologic features for this condition.…”

“…Tumor preventive treatment objectives for patients with chronic renal failure include normalizing blood levels of calcium and phosphate. [6] Treatment of hypocalcemia is based on oral and intravenous calcium replacement. Reported daily requirements of calcium in patients with severe hypocalcemia range from 6 to 16 g of elemental calcium per day.…”